MEDICARE: DR DRENNAN'S ADVANCED WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	33692	CA

General Provider Information

NPI Number	:	1467995225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR DRENNAN'S ADVANCED WELLNESS

Provider Business Mailing Address
First Line	:	5005 TEXAS ST STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3722
Country	:	US
Telephone Number	:	619-518-4222
Fax Number	:	619-255-3165

Provider Business Practice Location Address
First Line	:	5005 TEXAS ST STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3722
Country	:	US
Telephone Number	:	619-518-4222
Fax Number	:	619-255-3165

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	LACIE LYNN DRENNAN
Credential	:	D.C.
Telephone Number	:	619-518-4222

Provider Enumeration Date	:	11/28/2016
Last Update Date	:	03/20/2017

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